Use of extracts of the genus Cimicifugaas organoselective medicines for treating diseases of the genitourinary system caused by sex hormones

ABSTRACT

The present invention relates to extracts from  Cimicifuga  species and particularly from  Cimicifuga racemosa , which are suited for producing a ready-formulated drug for the selective treatment and/or prophylaxis of sexual hormone-related disorders of the uro-genital tract. The extracts in accordance with the invention are moreover suited for the treatment and/or prophylaxis of post-menopausal urinary bladder infections. They are furthermore indicated for the treatment of benign and malignant prostate hyperplasies.

The present invention relates to a use of extracts from Cimicifuga species.

It is known from WO99/47 149 (=EP1064009A1) to the applicant of the present application that extracts from Cimicifuga racemosa have an estrogenic effect not on the uterus, however in the hypothalamo-hypophysary axis, in the cardiovascular system, and in the bone. Insofar extracts from Cimicifuga racemosa have been utilized in order to produce an estrogen-type, organoselective medicament having no uterotrophic effect.

17β-estradiol, which is formed in women's ovaries (any mention of estradiol hereinbelow refers to physiological 17β-estradiol) [hereinafter also referred to as E₂], has a generally proliferation-enhancing effect in the organism. In addition to controlling the female cycle, it i. a. also has a homeostatic effect on the functions of urethra, bladder, and vagina. In men, locally formed estradiol as well as the male sexual hormone testosterone also have a proliferation-enhancing effect in the bladder and in the prostate.

During menopause, lowering of the estradiol level takes place due to cessation of the ovarial function. This results in weakening of proliferative processes in many organs, with subsequently occurring degeneration and reduced functional capacity.

With lack of estrogen, cystitis frequently develops in the post-menopausal woman as a consequence of reduced mucous membrane in the urethra and thus facilitated ascension of germs.

Urinary incontinence frequently occurring post-menopausally is equally caused by lack of estrogen. These disorders may be prevented or alleviated, respectively, by timely administration of estradiol.

Hormonal regulation of the function of the bladder in men presumably is similar to that in women; in any case the hitherto known regulative principles in the urinary bladder of male and female rats are very similar.

The administration of estrogens having a nonselective proliferative action is particularly adverse for uterus and breast tissue, for uncontrolled growth may occur here owing to the insufficiency or lack of gestagen counter-regulation.

Up to the present, there is no medicament available from plant drugs that might be used for an organoselective prophylaxis or therapy of changes in the uro-genital tract in the event of estrogen deficiency.

Starting out from this prior art, it accordingly is an object of the present invention to furnish plant medicaments having a sexual hormone-type action while having an organoselective action with no effect or only little effect on the uterus.

This object is achieved through the use of extracts from Cimicifuga species, particularly Cimicifuga racemosa.

In particular, the present invention relates to

-   -   use of extracts from Cimicifuga species, particularly Cimicifuga         racemosa, for producing an estrogen-type organoselective         medicament having no uterotrophic effect or one that is at least         negligible, wherein     -   the medicament is used for alleviating sexual hormone-related         disorders of the uro-genital tract.     -   Use is preferred in the following, post-menopausally occurring         disorders: cystitis and dry vagina.     -   Moreover the present invention relates to a use of extracts from         Cimicifuga species, particularly Cimicifuga racemosa, for         producing an estrogen-type organoselective medicament having no         uterotrophic effect or one that is at least negligible, wherein     -   the medicament is utilized for alleviating benign and malignant         prostate hyperplasy.

It was surprisingly found that Cimicifuga racemosa extract, for example from the rhizoma of Cimicifuga racemosa, also has effects similar to those of estradiol in the urinary bladder and in the urethra of ovarectomized rats. In the bladder both the estrogen receptor ER-alpha and ER-beta are expressed. It was found that estradiol and Cimicifuga analogously regulate down the gene expression of the estrogen receptor-alpha in the urinary bladder. Thus it appears that besides innervation, the bladder tonus may also be influenced through steroid hormones.

FIG. 1 shows a diagram which represents the differential bladder tonus of ovarectomized rats (group sizes: 12 animals). Following a three-month treatment of ovarectomized rats with Cimicifuga racemosa extract, the maximum pressure in the urinary bladder [in mm Hg] and the minimum pressure [in mm Hg] following relaxation of the bladder were determined by instillation of 1 ml of physiological saline solution.

The diagram in accordance with FIG. 1 shows on the ordinate the differential pressure [in mm Hg] between maximum and minimum pressure, which is an indication for the elasticity of the urinary bladder.

In comparison with placebo controls following a treatment with Cimicifuga extract, a significant dosage-dependent increase of bladder elasticity, measured through the pressure difference between relaxed and definedly filled bladder, is found.

In the test system, estradiol is found to be the most effective substance.

The highest Cimicifuga dose (400 mg/kg/d) triggers an effect comparable to that of the synthetic SERM (Selective Estrogen Receptor Modulator), Raloxifen.

Thus an additional effect of the extract on the urinary bladder, namely, an improvement of bladder incontinence, is equally proven.

Benign prostate hyperplasy and prostate carcinoma in men may also be influenced favorably by inhibition of the local estrogen production, but also by inhibiting synthesis of the male sexual hormones.

The like active mechanisms may also be demonstrated on the male castrated rat for the Cimicifuga racemosa extract. In the course of trials by the inventors of the present application, it was found that estradiol and the Cimicifuga extract significantly inhibit gene expression of the estrogen receptor of the alpha-subtype in the prostate without having an effect on the gene expression of the estrogen receptor-beta.

Both in in-vivo experiments in the rat prostate in the whole-body model and in human prostate carcinoma cells it was surprisingly found that Cimicifuga racemosa extracts have an anti-androgenic action favorably influencing prostate carcinoma and significantly inhibiting growth of the tumor cells in vitro.

In the prostate of castrated male rats, gene expression of the proliferation-enhancing growth factor IGF1 is moreover regulated up by testosterone, however regulated down by Cimicifuga, as is desired for reducing the hyperplasy. The prostate regression induced by castration could be antagonized in the rat by testosterone. In analogy with the findings in the case of castrated rats not treated with androgen (see above), the IGF1 expression regulated up by testosterone (see above) could also be regulated down by the Cimicifuga extract. These findings clearly demonstrate that the testosterone-induced prostate growth may be inhibited by extracts from Cimicifuga species.

In experiments on the human prostate-Ca line LNCAP, 5 alpha-dihydrotestosterone-induced proliferation and the production of its prostate-specific antigen (PSA) may significantly be inhibited by Cimicifuga species, particularly Cimicifuga racemosa.

Inasmuch as IGF1 always participates in the proliferation not only of benign but also malignant tumors, the inhibitory effect of extracts from Cimicifuga species on IGF1-gene expression in conjunction with this finding is evidence for an inhibitory effect on the prostate carcinoma.

As regards manufacture of the extract in accordance with the invention, WO99/47 149 is herewith fully included herein by reference, the essential features of which are, however, presently summarized as follows:

It was found through in-vitro and in-vivo experimentation that extracts produced both from Cimicifuga species, particularly Cimicifuga racemosa, with organic solvents or mixtures of organic solvents with water or with supercritical CO₂ have an organoselective effect on the uro-genital system, with an effect on the uterus being absent.

Thus the extracts used in accordance with the invention are suited for producing a ready-formulated medicament for the selective treatment and/or prophylaxis of sexual hormone-related disorders of the uro-genital tract.

Furthermore they are suitable for producing a ready-formulated medicament for the selective treatment and/or prophylaxis of post-menopausal urinary bladder infections.

They are moreover suited for producing a ready-formulated medicament for the treatment of benign and malignant prostate hyperplasies.

It was moreover found that enriched and/or pure ingredients or groups of ingredients from Cimicifuga species essentially have the same effects as the whole extract.

Ingredients or groups of ingredients to be particularly taken into consideration are the following: triterpenes, e.g., acteol and cimicigenol derivatives; polyphenols, such as caffeic acid and its derivatives, chlorogenic acid, piscidic acid, fucinolic acid, ferulic and isoferulic acid, cimicifugic acids; formononetine; alkaloids, e.g. cytisine and methylcytisine.

These ingredients are, besides in Cimicifuga racemosa, also found in additional Cimicifuga species such as, e.g., C. foetida, C. dahurica, C. heracleifolia, C. simplex, C. japonica, C. europaea, C. acerina, C. elata, C. rubifolia.

These further Cimicifuga species may thus also be used for producing extracts, and thus medicaments against the sexual hormone-related disorders of the uro-genital tract that are being mentioned in the context of the present invention.

Preferably rhizoma, roots, stalks, leaves and/or petals of the plants are used for producing the extracts. 

1. A method for alleviating a prostatic disorder selected from the group consisting of benign and malignant prostate hyperplasy comprising the step of administering an estrogen-type organoselective medicament to alleviate the prostatic disorder, the medicament comprising an extract from a Cimicifuga species.
 2. The method of claim 1 wherein the Cimicifuga species is selected from the group consisting of: C. racemosa, C. foetida, C. dahurica, C. heracleifolia, C. simplex, C. japonica, C. europaea, C. acerina, C. elata, C. rubifolia.
 3. The method of claim 2 wherein the Cimicifuga species is C. racemosa.
 4. The method of claim 1 wherein the extract is produced from a Cimicifuga species by extraction with an organic solvent, such that the method alleviates the prostatic disorder.
 5. The method of claim 1 wherein the extract is produced from a Cimicifuga species by extraction with a mixture of an organic solvent and water, such that the method alleviates the prostatic disorder.
 6. The method of claim 1 wherein the extract is produced from a Cimicifuga species by extraction with supercritical CO₂, such that the method alleviates the prostatic disorder. 